Individual
LISA R JACOBS
Active
Individual
LISA R JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2435
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11605559
CAQH PIN
CO
05
—
29277523
—
CO
01
—
PSY.0002435
PROFESSIONAL LICENSE
CO
Enumeration date
02/17/2006
Last updated
05/19/2022
Update your record
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